Two-dimensional elastography and dispersion slope for allograft evaluation after pediatric liver transplantation
Jeong Min Song1, In Hye Song2, Hee Mang Yoon1
1Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Purpose:
This study evaluated the diagnostic performance of two-dimensional shear-wave elastography (2D SWE) for assessing allograft pathology in pediatric liver transplantation (LT) recipients, with subgroup analyses according to sonographic approach and age group. Additionally, the present study aimed to identify factors associated with SWE-derived parameters.
Methods:
This study retrospectively analyzed pediatric LT recipients who had received a left lobe or left lateral segment graft during childhood and underwent paired 2D SWE and liver biopsy. Associations between elasticity and dispersion slope measurements and clinicopathologic parameters were evaluated using univariable and multivariable regression analyses. Subgroup analyses were performed according to sonographic approach and age group. Diagnostic performance was assessed using receiver operating characteristic analysis.
Results:
A total of 108 patients (median age, 13.4 years; 47 males) were included. Elasticity measured using the intercostal approach in patients aged ≥13 years showed significant associations with METAVIR (Meta-analysis of Histological Data in Viral Hepatitis) fibrosis grade, necroinflammatory activity grade, liver allograft fibrosis score, and rejection activity index score. In multivariable analysis incorporating clinical parameters, METAVIR fibrosis grade remained the only independent predictor of intercostal elasticity in this age group (coefficient, 2.17; P<0.001). Intercostal elasticity demonstrated excellent diagnostic performance for distinguishing F0-F2 from F3-F4 fibrosis (area under the curve [AUC], 0.95; P<0.001; cut-off, 11.0 kPa) and good performance for distinguishing F0-F1 from F2-F4 fibrosis (AUC, 0.83; P<0.001; cut-off, 7.2 kPa). In contrast, subcostal measurements and dispersion slope showed no significant association with any pathologic parameter.
Conclusion:
Intercostal elasticity demonstrated diagnostic value for predicting graft fibrosis in pediatric LT recipients aged ≥13 years who received left lobe or left lateral segment grafts. Among the evaluated clinicopathologic parameters, METAVIR fibrosis grade was the only independent predictor of elasticity in this subgroup.
